#1

Question 1

AAA

Answer 1

Asymptomatic unless rupture

If below renal artery can resection

Men > 60 years typical CVD RFs

If less than 55mm conservative

Larger = endo surgery stent

Rupture fatal

Question 2

Amyloidosis

Answer 2

Deposition of amyloid protein, many organs

Classified by amyloid type, heritable for some

Alzheimer’s caused by same process

Rare

More likely in chronic inflammation pt

Restrictive cardiomyopathy if coronary deposition

Diagnose biopsy, ISAP scan

Symptomatic treatment

Extreme anti inflammatory treatment

AL much worse than AA type

Question 3

Aortic Dissection

Answer 3

Intima torn

Blood into false lumen

Connective tissue disease, coarctation, aortitis, trauma, cocaine, ASD cause

Type A ascending B descending

False lumen can obstruct other key arteries

Men 40-60

Tearing pain, syncope, angina, paraplegia, ataxia

Collapsing pulse, wide PP

Diagnose with imaging

Restore blood volume ITU

Surgical graft for A

Stent for B

Question 4

Aortic Regurgitation

Answer 4

Reflux from aorta into LV

Abnormal valve due to syphilis, congenital, endocarditis, RF, trauma

Or due to aortic dilurtation (HTN, dissection etc)

Asymptomatic –> HF symptoms

Causes cardiomegaly, PO, LVH

Valve replaced if bad

Question 5

Aortic stenosis

Answer 5

RF, bicuspid, degeneration

Men > women

Angina, syncope, HF signs

Narrow PP, slow rising pulse

Softer S2 = worse

Carotid radiation

LVH on ECG (deep S wave V1&2, tall R V56)

Valve replaced, Abx prophylaxis, balloon dilation

Can lead to sudden death, MI etc

5 year survival if symptomatic

Question 6

Arterial ulcer

Answer 6

Blocked peripheral arteries

Angioplasty / endartectomy / bypass

CVD risk factors especially diabetes

Ulcer caused by near ischaemia

Question 7

Angina

Answer 7

Exertional = stable

Decubitus = night recumbent

Prinzmetal’s = vasospasm at rest, exercise okay

Unstable = at rest

Aspirin, statin, GTN, B blocker, Calantag

CABG / PTCA

Question 8

Acute Coronary Syndrome

Answer 8

STEMI or NSTEMI

STEMI = thrombolytics, angioplasty

NSTEMI = clopidogrel, heparin etc

Can be atypical

History ECG troponin diagnoses

Streptokinase tPA

Can lead to other heart conditions

Question 9

Heart block

Answer 9

1st degree slightly long PR do nothing

2nd degree 1 = progressively longer then drop
2 = normal PRI random drop

3 no pQRS assoc at all

RBBB = M v1 W v6

LBBB = W v1 M v6

Both can be caused by MI, L can be aortic stenosis, R can be hyperkalaemia congenital

Question 10

Causes of heart block

Answer 10

Can be autoimmune

Congenital

MI most common

SOB fainting fatigue

Give pacemaker or remove cause

Question 11

Cardiogenic shock

Answer 11

Any cause of acute HF

Give oxygen

Analgesia

ECG

Positive inotropes

Dopamine

Question 12

Cardiac tamponade

Answer 12

Falling BP

Increased JVP

Muffled HS

Question 13

Right heart failure

Answer 13

Fatigue 
SOB
Nausea 
Raised JVP
Pitting oedema 
Ascites 
PO

Question 14

Left heart failure

Answer 14

Fatigue 
Exertional dyspnea
Orthopnea
Cardiomegaly 
Displaced apex
Mitral regurgitation 
Lung crackles if late 

Congestive is RF secondary to left

Question 15

Infective endocarditis

Answer 15

Heart lining or endothelium

More likely if valve abnormal

S viridans
S aureus
E faecalis

Subacute - typical illness signs, HF symptoms, renal failure, murmurs

Positive blood culture normally, scans and blood markers

Treat primary infection and give 2 weeks IV 4 weeks oral Abx

Surgery if large vegetation & emboli

Prosthetic valves do much worse